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9 ERMIT APPLICATIJN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425.257-8857 <br />SITE ADDRESS) <br />PARCEL TAX I.D. A <br />PERMIT . <br />170� 73' - c F <br />3 zay3Goo10D-7 00 <br />I QoA 1 ;t-o/c) <br />LEGA LOT NO.S rJ 20� <br />Desc. 9ditt,6 <br />BLOCK <br />1),Kp00�D-00" <br />TRACT <br />5ec3(o l' ,P 32- 9&E 71/ S I/t SE I/y t& 11,4 NE I/y <br />1"16F7- <br />OWNER f.T'rn ADDRESS ZIP PHONE q25-3c/X 66- <br />f {7)249;&(l 170Y 7 ,"? °t EV et <br />TENANT I <br />CONTACT NAME PHONE <br />r. <br />�nLa. �An_ia.e(f 4 <br />CONTRACTOR ADDRESS �� ` N C ZIP CONTR. LICENSE a <br />W�IRrS s7r uct 530S 8(r, �%$'27U PnLc 1F �{SbN6 <br />1n�fln <br />PHONE !S'la r4,(vrl (-.t <br />Nz;-3y5-Syg9 <br />PROPOSED USE OF BUILDING <br />'Q) Building n Mechani9al <br />('� Addition <br />I HEAT SOURCE <br />nee, <br />I PERMIT <br />Combination jLHJj Plumbin <br />WORK <br />I <br />Alteration <br />D Eleclnc <br />TYPE <br />Demolition Sign <br />TYPE <br />IjF2-J�( New <br />FLr-.(1f Gas <br />IjrHJ(j <br />Sprinkler <br />Repaiuhlawl <br />u NL(11her <br />CONTRACT PRICE OF WOR 5,000. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCRIPTION-D15r ft"rLff- E y� Go.-c.�[�i •o ��5 e.• ttC�ST..�� Cv.. c.}r <br />SL..h. 114i .-.ld 2 4r,,,) wwlly - ca f�- w;Tf. sl uT, /Btds </r../S, %,'S Rom,, ..� Zk" <br />ck,.Jl,, /vhr.. 6..ru.� �/-�. wTnf re..E'rs . As Jy.d',.�< - <br />/ll'Si' <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE: OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET / <br />A/C - A,HANDLING UNI <br />ATHTUp <br />_ <br />_ <br />FORCED AIR SYSTE <br />_ <br />L VATORY (WAS BASIN) <br />HEAT PUMP <br />_ <br />S WER <br />UNIT HEATERS <br />_ <br />_ <br />KIT EN SINK DISPOSAL <br />_ <br />CLOTHES DR R <br />DISH ASHER <br />7ANGE HO <br />_ <br />LAUN Y T Y <br />ER H TER <br />_ <br />_ <br />CLOTH W' SHER <br />AL F EPLACE'STOVE <br />URINAL <br />P CE INSERT <br />_ <br />DRINKING -OUNTAIN <br />F EPLACE <br />_ <br />FLOOR D N <br />ANGE <br />)GA <br />_ <br />BACKFL W EVENTER <br />P ING <br />_ <br />SINK IS RVIC �BAR/MOP/ETC.) <br />UTFAN <br />OTHER <br />ER <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TC BE TRUE AND COFIRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF IS PROPERTY TO PERFORM THE WORK FOP WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COI�TR'YrO�S yAW 18.27 RCW AND 296200 WAG. <br />O %- _ <br />ale �Z <br />k <br />